Microendoscopic Removal of Deep-Seated Brain Tumors Using Tubular Retraction System

Abstract

Background Retraction of the overlying brain can be difficult without causing significant trauma when using traditional brain retractors with blades. These retractors may produce focal pressure and may result in brain contusion or infarction. Tubular retractors offer the advantage of low retracting pressure that is less likely to be traumatic. Low retraction pressure in the tubular retractor is due to the distribution of retraction force in all directions in a larger area. Material and Methods We conducted a retrospective study of 100 patients with deepseated tumors operated on from January 2010 to December 2014. Tumor removal was accomplished with the help of a microscope and/or endoscope. Tubular brain retractors sizes 23, 18, and 15 mm were used. Folding of the tubular retractor after making a longitudinal cut allowed a small corticectomy. Larger retractor sizes were used in the earlier part of the study and in larger tumors. All the patients were evaluated postoperatively by computed tomography scan on the first postoperative day, and subsequent scans were done as and when needed. Any brain contusion or infarctions and the amount of tumor removal were recorded. Results A total of 74 patients had astrocytomas; 12, meningiomas; 4, colloid cyst of the third ventricle; 4, metastases; 4, primitive neuroectodermal tumor; 1, neurocytoma; and 1, ependymoma. Pure endoscopic excision without using a microscope was performed in 12 patients. Lesions were in the frontal (n ¼ 34), parietal (n ¼ 22), intraventricular (n ¼ 16), basal ganglion or thalamic (n ¼ 14), occipital (n ¼ 10), and cerebellar (n ¼ 4) areas. Total, near-total, and partial excision was achieved in 49, 29, and 22 patients, respectively. Use of a conventional retractor for excision of peripheral and superficial parts of a large tumor, small brain contusions, and technical failure were observed in 7, 4, and 1 patient, respectively. The low incidence of contusion may be partly due to the nonavailability of magnetic resonance imaging in the early postoperative period because of financial constraints. Conclusion Removal of deep-seated tumors was safe and effective using our simple tubular retractor. It also helped minimize bleeding during surgery. A tubular brain retractor and conventional retractor can be used to complement each other if required.

Endoscopic Management of Spinal Intradural Extramedullary Tumors

“…Endoscopy is being used increasingly in spine, [11][12][13] skull base, [14][15][16] and cranial surgery. [17][18][19][20] It is also useful for various types of pathologies such as congenital lesions, 21,22 hematoma evacuation, [23][24][25] tumor excisions, [26][27][28] and for infective pathologies. 29,30 Endoscopic technique for intradural extramedullary spinal tumor removal has been found to be safe and effective in our series.…”

Practical aspects in neuroendoscopic techniques and complication avoidance: a systematic review.

“…This maneuver also helps to visualize and introduce instruments in a blind area (area between skin and lens tip), especially when a scope holder is used. Site and size of the incision should be properly planned, as there is less flexibility in a small exposure (17,26). Second option of microscopic surgery, using the same incision, should be planned especially at the beginning of the learning curve and in difficult cases.…”

“…Likewise, if the tissue is pulled towards the lens tip, its bed and distal part of tissue is not visualized and might contain adherent vessel or nerve ( Figure 5A). On the other hand, if the structure (17,29,31). The instruments used in endoscopic surgery are usually long with a power grip design.…”

“…To properly view a tissue lying in the left corner of the surgical field, one needs to direct the scope towards the left side; if shaft and slender instruments are preferred over double shaft and bulky instruments (17,26,29). Instrument manipulation may become difficult if the scope is near the target ( Figure 8A).…”

“…Instrument manipulation may become difficult if the scope is near the target ( Figure 8A). Although the telescope cannot be placed too far away from the required object due to its shorter focal length, it should be stationed as much away as possible ( Figure 8B) to prevent obstruction of instrument manipulation (17). There should not be any sword fighting effect (scope is pointing in one direction and the instrument in the opposite direction).…”